title: Endoscopy-assisted transanal division of an apical pouch bridge after restorative proctocolectomy with a J-shaped ileal pouch.
abstract: Restorative proctocolectomy and J-shaped ileal pouch-anal anastomosis have been performed as a standard operation for ulcerative colitis. However, functional problems are sometimes troublesome in the postoperative period. The J pouch was constructed from 2 ileal limbs using the gastrointestinal anastomosis (GIA) stapler. A residual mucosal bridge remained because the stapler had a safety margin at the top of the cartridge. Apical pouch bridge is a residual septum above the ileoanal anastomosis. There are several reports of so-called apical pouch bridge syndrome due to outlet obstruction of the J-shaped ileal pouch by an apical bridge. Division of this septum can resolve the outlet obstruction. We describe a successful endoscopic procedure for division of an apical pouch bridge. An Endo-GIA stapler was introduced into the ileal pouch alongside the endoscope, and division of the apical bridge required a few firings of the Endo-GIA stapler under transanal endoscopic guidance. The symptoms related to the apical pouch bridge were resolved completely without creation of an ileostomy.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan. k-takagi@dokkyomed.ac.jp
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Takagi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nagata
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishizuka
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakuraoka
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D013528:Surgical Staplers